Athens Eye Hospital

Postoperative endophthalmitis is a rare but vision-threatening complication of cataract surgery. Multidrug-resistant organisms present additional therapeutic challenges. We report a 52-year-old man who underwent uncomplicated phacoemulsification for posterior subcapsular cataract. On the first postoperative day, visual acuity was 8/10, but inflammation gradually appeared without the classic signs of endophthalmitis. On the fifth postoperative day, the patient's vision deteriorated significantly, reaching 1/10, accompanied by a strong inflammatory reaction in the anterior chamber. A pars plana vitrectomy was performed and vancomycin and ceftazidime were administered intravitreally. Staphylococcus hominis, resistant to most common antibiotics but sensitive to gentamicin, was isolated from the vitreous culture. The medication was modified accordingly, with topical gentamicin and oral doxycycline, under daily close monitoring. One month later, cystoid macular edema appeared, which was successfully treated with acetazolamide, topical corticosteroids, and bromfenac. Three months after surgery, the patient's vision had returned to 9/10 without any permanent damage. Early surgical intervention, culture-guided therapy, and intensive follow-up can preserve vision even in postoperative endophthalmitis due to multidrug-resistant organisms.

To assess the effectiveness of the transconjunctival suprachoroidal buckle (TSCB) technique in treating primary rhegmatogenous retinal detachment (RRD). A prospective interventional study including patients with primary RRD undergoing the TSCB technique. The technique consisted of a transconjunctival approach using an olive tip handled cannula with an Atkinson 25-gauge needle tip that injects a high-purity gel in the suprachoroidal space (SCS) and creates a buckle effect that lasts for 12–18 months. Indirect laser retinopexy is done in the operating room or in the early post-operative office visit on the slit lamp. The TSCB technique could be done in the office in selected cases of uncomplicated RRD. The study included 31 eyes of 31 patients. Seventeen eyes were phakic (55%). The RRD involved one quadrant in 81% of eyes. Sixteen eyes (52%) had more than one break. The TSCB procedure was performed in the operating room in 21 patients (68%). The mean duration of follow-up was 5 months. Postoperatively, we achieved retinal attachment in all patients. Three patients (10%) needed a second surgery. Two patients (6%) developed dot hemorrhage due to choroidal puncture. The TSCB is safe, and avoids the complications of conventional scleral buckling.

ABSTRACT Purpose To report the incidence of treatment-requiring retinopathy of prematurity (ROP) in Greece at a national level. Methods Multicenter prospective cohort study of infants that required treatment for ROP at any unit in Greece between June 1st, 2020, and May 31st, 2021. Twelve out of the 13 invited centers contributed their data. Collected parameters included infants’ demographics, ROP examination findings prior to treatment, and treatment characteristics. Results The overall incidence of treatment-requiring ROP (TR-ROP) was 3.8%, given the fact that 1133 live births of infants with GA <32 weeks and/or BW < 1501 g were reported during the study period. Median (range) gestational age and birth weight of treated infants were 26.9 (23.4–33.0) weeks and 850 (500–2370) g, respectively, and 55.8% were male. The most prevalent ROP severity among treated infants was type 1 ROP (70 eyes), followed by type 2 ROP (8 eyes) and aggressive ROP (6 eyes). Laser photocoagulation (69.8%) was the predominant treatment modality used vs intravitreal anti-VEGF injections (30.2%). The median postnatal age at initial treatment was 9.6 weeks (range 5.6–21.7). Re-treatment rate was 30.2% and was higher among infants treated with anti-VEGF (69.2%) vs laser (13.3%). Treatment failure was reported in one case (progression to stage 4B in one eye and stage 5 in the other), whereas ROP regressed in all other patients. Conclusion This is the first study to report TR-ROP incidence in Greece, treated infants’ characteristics at a national level, preferred practice patterns, failure rate and recurrence rate at 6 months from initial treatment.

In the realm of ophthalmic surgeries, silicone oil is often utilized as a tamponade agent for repairing retinal detachments, but it necessitates subsequent removal. This study harnesses the power of machine learning to analyze the macular and optic disc perfusion changes pre and post-silicone oil removal, using Optical Coherence Tomography Angiography (OCTA) data. Building upon the foundational work of prior research, our investigation employs Gaussian Process Regression (GPR) and Long Short-Term Memory (LSTM) networks to create predictive models based on OCTA scans. We conducted a comparative analysis focusing on the flow in the outer retina and vessel density in the deep capillary plexus (superior-hemi and perifovea) to track perfusion changes across different time points. Our findings indicate that while machine learning models predict the flow in the outer retina with reasonable accuracy, predicting the vessel density in the deep capillary plexus (particularly in the superior-hemi and perifovea regions) remains challenging. These results underscore the potential of machine learning to contribute to personalized patient care in ophthalmology, despite the inherent complexities in predicting ocular perfusion changes.

This research aimed to compare the measurements recorded by a traditional PCI technology biometer (Partial Coherence Interferometry) and by a SS-OCT (Swept Source Optical Coherence Tomography) technology machine in preoperative screening of patients with age-related cataract. Optical biometry was performed with the IOLMaster 500 (version 5.5, Carl Zeiss Meditec, Germany) and the ANTERION (Heidelberg Engineering, Germany) in a total sample of 144 eyes, from 80 patients, (37 men and 43 women), with a mean age of 70.54 ± 0.739 years (range: 45-89 years) and the values of the Axial Length (AL), two meridians of the cornea (Kf, Kflat and Ks, Ksteep), astigmatism (Ast) as well as the Anterior Chamber Depth (ACD) were compared with the program IBM SPSS Statistics 27. The IOLMaster500 and ANTERION devices did not have statistically significant differences in terms of axial length and flat corneal meridian Kf, while they differed statistically significantly in terms of steep corneal meridian Ks, astigmatism and anterior chamber depth. This study suggests that a thorough pre-operative check must be performed, sometimes with more than one device, aiming at greater accuracy in the measurements of the ocular biometrics, so that we achieve more successful postoperative outcomes and ultimately more satisfied patients.

A 26-year-old female patient presented with sudden, painless visual disturbances in her right eye (RE). Fundus examination revealed signs of a central retinal vein occlusion (CRVO) (hemorrhages, mild venous tortuosity, mild disc swelling, and blurred disc margins), as well as a white ischemic area nasal to the optic nerve, suggesting a possible cilioretinal artery occlusion (CLRAO). A diagnosis of combined CRVO and nasal CLRAO with homozygosity for the C677T mutation in the methylenetetrahydrofolate reductase (MTHFR) gene and elevated levels of serum homocysteine was made. The patient was prescribed folic and acetylsalicylic acid and subsequent follow-up demonstrated gradual improvement.

Background: Ocular hypertension (OH) is a condition characterized by elevated intraocular pressure (IOP) exceeding the normal range, without any evident damage to the optic nerve or visual field defects characteristic of glaucoma. It constitutes a significant precursor to the development of glaucoma, a leading cause of irreversible vision loss worldwide. Emerging evidence has shown that microcirculation alterations in eyes with OH could serve as predicting factors to identify eyes at high risk for progression to glaucoma. In view of the above, the purpose of our study is to investigate microcirculation alterations of the radial peripapillary capillary plexus using optical coherence tomography angiography (OCT-A) in patients with ocular hypertension (OH).Methods: A total of 192 eyes were included in this observational, comparative, single-centre study and were divided in two groups: OH eyes and healthy controls. OCT-A was performed to analyze microcirculation characteristics at the peripapillary area. Radial peripapillary capillary density was measured at the total area of the optic disc and at each separate region (superior, inferior, inside). The parameters of age, medical treatment for ocular hypertension, sex and retinal fiber layer thickness were evaluated.Results: Total radial peripapillary capillary density was significantly lower in patients with OH than in healthy controls Concerning the microcirculation characteristics at each separate region of the peripapillary area, the results were as follows: inferior radial peripapillary capillary density was significantly decreased in individuals with OH than in controls, while measurements in the superior peripapillary area and internal optic disc were similar in both groups.Conclusions: Our study indicates decreased radial peripapillary capillary density in eyes with OH. Microcirculation alterations in the inferior peripapillary area could potentially comprise biomarkers for OH progression to glaucoma.

The aim of this study was to present a case of transepithelial photorefractive keratectomy (trans-PRK) laser ablation in a patient with partial limbal stem cell deficiency (LSCD) that resulted in corneal irregularity. A 23-year-old man with bilateral partial LSCD underwent trans-PRK for myopia correction 2 months before presentation to our department. Trans-PRK ablation was performed with a phototherapeutic keratectomy ablation profile set at 60 μm in the OD and 57 μm in the OS and 8 mm zone. At the time of presentation, the patient complained of decreased visual acuity. Corrected distant visual acuity was 20/20 (-3.25, -0.75 × 180 degrees) and 20/50 (-3.00, -3.00 × 180 degrees) in the OD and the OS, respectively. No further ocular history was reported other than prolonged soft contact lens use for myopia. Pre-trans-PRK tomography (WaveLight Oculyzer II diagnostic system, WaveLight GmbH, Germany) revealed bilateral superior steepening with corresponding epithelial thinning as obtained by the epithelial map using Optovue optical coherence tomography (Visionix Luneau technology). Slit-lamp examination showed bilateral superficial neovascularization, suggestive of early-stage LSCD. A nonuniform laser stromal ablation resulting in corneal irregularity and decreased visual acuity was observed 2 months postoperatively. During the 6-month follow-up, corneal tomography was stable with only minimal improvement. At that time, corrected distant visual acuity remained 20/20 (-2.75, -0.75 × 160 degrees) in the OD and 20/50 (-3.00, -3.00 × 180 degrees) in the OS. Trans-PRK seems to be a contraindication in cases with corneal epithelial irregularities and could lead to abnormal and nonuniform stromal ablation .

To evaluate the impacts of phacoemulsification preoperative and intraoperative factors on postoperative subfoveal choroidal thickness (SFCT). This prospective interventional study was conducted on patients undergoing uneventful phacoemulsification with posterior chamber intraocular lens (IOL) implantation at the private clinic Ophthalmica Eye Institute, in Thessaloniki, Greece. Forty-six eyes of 46 patients were included in the study. Operative time (OT), phacoemulsification time (PT), effective phacoemulsification time (EPT) and phacoemulsification power (PP) were recorded for each patient. All patients received dexamethasone and nepafenac drops for 4weeks postoperatively. Choroidal thickness (CT) at five anatomical locations was measured preoperatively and at 1week, 1month and 3months postoperatively. Subfoveal choroidal thickness significantly increased over baseline thickness at 1week postoperatively, returned to preoperative levels at 1month and increased again at 3months. Changes at 1week and 3months postoperatively correlated to baseline choroidal thickness (p = 0.023 and p = 0.011, respectively). Spherical equivalent (SE) inversely correlated to SFCT throughout the entire follow-up period (baseline p = 0.044, 1-week p = 0.011, 1-month p = 0.013, 3-month p = 0.018). EPT was the most significant determinant of increased SFCT at all time points (1-week p = 0.011, 1-month p = 0.01, 3-month p = 0.015). PT and PP significantly correlated to the SFCT increase at 3months postoperatively (p = 0.033 and p = 0.043, respectively). OT was not associated with a change in SFCT at any time point (p > 0.05). Phacoemulsification can alter choroidal thickness until at least 3months after surgery. Preoperative and intraoperative factors, notably SE, baseline SFCT, PT, PP and especially EPT, can influence postoperative CT increase.